甲状腺乳头状癌与甲状腺结节钙化的关系探讨

目前恶性肿瘤的诊断方法日益丰富，临床医师在选择检查手段时也面临多种选择，而对于同一个肿瘤不同的检查方法或许会出现截然不同的结果，对此临床医师需要全面思考和判断。现介绍1例天津医科大学附属肿瘤医院多学科综合讨论病例供大家参考。本例患者主因“恶性腹水”就诊，PET-CT检查发现甲状腺、腮腺和脐部等多处病变，考虑恶性，而B超检查考虑甲状腺和腮腺病变为良性，脐部病变为转移瘤。针吸活检诊断脐部病变为转移性腺癌，但所有检查未能确诊原发病灶。最终，经过分析其影像学表现、病理特征和免疫组化指标，多学科咨询委员会认为本例患者应诊断为腹膜癌。通过本病例讨论，认为病理诊断仍是恶性肿瘤诊断的金标准，合理的免疫组化结果对于确定癌灶的来源有较大的指导意义。

A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma

Malignant tumor may be detected using various diagnostic methods. Different techniques can reveal various results for the same lesion; thus, clinicians must seriously consider the approach selected. This study introduces a case that was the subject of a multidisciplinary comprehensive discussion at the Tianjin Medical University Cancer Institute and Hospital. A patient presented with malignant ascites. Positron emission tomography-computed tomography examination revealed more thyroid, parotid gland, and umbilical lesions, which were all considered malignant. B-mode ultrasound was used to assess the thyroid and parotid benign lesions, as well as the umbilical lesions for metastatic tumor. The primary lesions were not definite although the umbilical lesions were metastatic adenocarcinoma, as determined by aspiration biopsy. The multidisciplinary consultation committee determined that the patient had peritoneal carcinoma through analysis of radiologic, pathologic, and immunohistochemical characteristics. This case presentation suggests that the pathological approach remains the gold standard for malignant tumor diagnosis. Reasonable selection of an immunohistochemical item to determine the source of the carcinoma is considerably significant.